Health Weekly: The ‘poor cousins’ of Canadian health care

As most with most health files, the contrast between Canada’s paralytic approach and that of other nations was painfully apparent as the Mental Health Commission of Canada released its first set of mental health indicators, while Britain launched a bid to achieve “zero suicides” and issued new guidelines for doctors treating patients with mental health problems.

The report flags four of the 13 indicators as moving in “an undesirable direction,” to wit: 16.5 per cent of Canadians report very high levels of stress associated with providing care to a family member with a long-term health condition; just one-third “aged 12 and older, with common mental health conditions report very positive mental health;” 6.6 per cent of Canadian college students reported intentional self-harm; while the national suicide rate, 10.8 per 100,000 people (3,728 in 2011), is high in comparison to other G8 nations.

Two of the 13 indicators are related to access and treatment and both are graded as areas of “some concerns, mixed or uncertain results.” One is mental health hospital readmissions within 30 days, which top 10 per cent and “might be due to a lack of stabilization during the previous visit, poor discharge planning or not enough community support.” The other is “unmet need for mental health care,” with 26.3 per cent of Canadians over age 15 reporting in 2012 that “they didn’t receive care they needed for their emotions, mental health or use of alcohol or drugs.”

Commission official Jennifer Vornbrock told reporters that in Canada, mental health is “the poor cousin of the poor cousin of the health-care system.”

Although the commission has released a Mental Health Strategy for Canada, it has not resulted in a commensurate increase in investment in community services or in the mental health share of overall health spending, which the Canadian Mental Health Commission has estimated was about $5.22 per capita in 2011, as compared with $198.93 in New Zealand, $98.13 in Australia and $62.22 in the United Kingdom.

Meanwhile, UK Deputy Prime Minister Nick Clegg this week told a Mental Health Conference convened to discuss the future of mental health services in England that National Health Services trusts must aim for “zero suicides” as part of a bid to reduce the country’s 4,700 annual suicide death toll. Methods could include “bringing safety systems in line with treatment for physical health – for example, designing a process for any member of staff to follow if a patient is at high risk of suicide. This would tell staff what to do, who to call, where to send the patient, and how to follow it up; [and] joining all services up so that patients who are at risk will not fall through the cracks – linking GP [general practitioners], carers and mental health services.”

The United Kingdom’s Department of Health, in turn, unveiled a revised code of practice for the Mental Health Act 1983 to guide clinicians on “how to carry out their roles and responsibilities” in providing care to patients with mental health problems. The revised code says clinicians should use five principles “when making all decisions in relation to care, support or treatment provided under the Act: Least restrictive option and maximising independence; Empowerment and involvement; Respect and dignity; Purpose and effectiveness; and Efficiency and equity.”

The Conservative government’s assault on registered charities, which has seen environmental, foreign aid, human rights and poverty reduction groups scrutinized for ostensibly conducting political activities antithetical to Prime Minister Stephen Harper’s ideological beliefs, has now resulted in Dying With Dignity Canada stripped of its charitable status. The organization took issue with the Canada Revenue Agency assertion that it did not undertake educational activities. “The organization educates about the case for physician assisted dying, provides information about patient rights and advance care planning, and offers one-on-one support to individuals who are dying and want to do so on their own terms. In addition to making the case for the legalization of physician assisted dying, the charity had categorized a number of its activities as advancing education, such as its: workshops and presentations; quarterly newsletter; website; and advance care planning resource kits.” Although the change means Dying with Dignity will no longer be allowed to issue charitable receipts, it plans to reconstitute itself as a non-governmental organization, which will allow it to actively campaign in the next federal election.

Many employers in Canada are surprised to find that 35 per cent of the Canadian workforce is providing informal health care to family member or friend, rarely have policies in place to support such workers, and “would like to better understand the business case for supporting employee caregivers in the workplace,” according to a report from the federal Employer Panel for Caregivers. “Business case information would help to sell the concept of caregiver support to senior leadership, and provide a framework for evaluating the level of involvement,” states the report, When WORK and CAREGIVING Collide. The report notes that there is a substantial “risk” for employers whose staff are providing care to family.

Minister of State (Seniors) Alice Wong announced that the Toronto-based Aging Gracefully across Environments using Technology to Support Wellness, Engagement, and Long Life—AGE-WELL, one of four new national centres-of-excellencecreated in the tri-granting council 2015 research networks competition, will receive $36.6 million over five years for its operations. The network’s aim is to “identify the needs of seniorsand find ways to reduce the burden on their caregivers.”

Western Economic Diversification announced that it will contribute $2.98 million toward the purchase of equipment at the University of Alberta’s new Metabolomics Technology Demonstration Centre. “The equipment, a 700 MHz Nuclear Magnetic Resonance machine and a Quadrupole-Time of Flight Mass Spectrometer, will assist companies in the metabolomics sector move biomarkers from the research lab to the medical testing facility. Companies will test, validate, and assemble prototype kits using existing research from the University’s Metabolomics Innovation Centre’s biomarker panels, to cost-effectively create more accurate and less invasive medical tests.”

In the latest of a series of articles on pharmacy errors, CBC Marketplace reported that “some Canadian pharmacists are saying they are under intense pressure to meet business quotas, which causes an assembly-line mentality that increases the likelihood of making mistakes.”

From the provinces:

Eleven-year-old Makayla Sault, one of two aboriginal children who last year became cause celebres for Ongwehowe Onongwatri:yo: (indigenous medicines), is “safely in the arms of Jesus,” the child’s family announced.

The aboriginal community lined-up behind Sault’s desire to discontinue treatment after she asserted that “chemo is killing by body” and that Christ had entered her room and told her “not to be afraid.” Her family supported her decision, claiming that children in aboriginal culture have equal voice to adults, irrespective of whether medical evidence indicates there is a 70 per cent survival rate for those treated with chemotherapy. Association of Iroquois and Allied Indians Grand Chief Gordon Peters asserted that “the suggestion by hospital officials that using our traditional methods of healthcare is ‘irrational’ or ‘not of a sound mind’ is beyond insulting and must be rejected outright.” The McMaster Children’s Hospital had sought continuation of chemotherapy but the Children’s Aid Society of Brant concluded she should not be compelled to continue receiving treatment.

Canadian court decisions on the issue of children making medical decisions have been equivocal, revolving around the issue of whether age and capacity should be determining factors. The Supreme Court of Canada weighed in on the issue with a three-opinion, split 4-2-1 decision in 2009, ruling in A.C. v. Manitoba (Director of Child and Family Services) that the wishes of a child demonstrating “mature, independent” judgment should be respected.

Big pharma’s drive for profits is contributing more to antimicrobial resistance than over-prescribing by physicians, according to Karl Rotthier, chief executive officer of Dutch-based DSM Sinochem Pharmaceuticals.

“Most antibiotics are now produced in China and India and I don’t think it is unjust to say that the environmental conditions have been quite different in these regions. Poor controls mean that antibiotics are leaking out and getting into drinking water. They are in the fish and cattle that we eat and global travel and exports means bacteria is travelling. That is having a greater contribution to the growth of antibiotic resistance than overprescribing.”

“At the moment we risk ‘sleepwalking’ towards the end of medicine as we know it, to an era when something as innocuous as a throat infection becomes a life-threatening condition and when treatments such as transplant surgery become impossible,” Rotthier added.

As part of a bid to ensure that allocation of transplantable organs is equitable and transparent, the Organ and Tissue Authority and Transplantation Society of Australia and New Zealand has released draft Ethical guidelines for organ transplantation from deceased donorsfor public consultation. “There must be no arbitrary discrimination against potential recipients on the basis of: race, religious belief, gender, marital status, sexuality, social or other status, disability or age; need for a transplant arising from the medical consequences of past lifestyle; capacity to pay; location of residence (e.g. remote, rural, regional or metropolitan); or refusal to participate in research,” the guidelines note. “However, it is ethically acceptable for the following factors to be taken into account when considering eligibility for transplantation: relative severity of illness and disability and urgency of the need for transplant (e.g. imminent death); general health including factors that will directly affect the likelihood of a poor outcome, such as degree of frailty and relevant medical conditions; and reasonable likelihood that the recipient will be able to adhere to the necessary ongoing treatment and health advice after transplantation.”

United States President Barack Obama vowed in his State of the Union addressto launch a “precision medicine” initiative that will aim to improve disease treatment by utilizing genetic information. “I want the country that eliminated polio and mapped the human genome to lead a new era of medicine—one that delivers the right treatment at the right time,” Obama said. “In some patients with cystic fibrosis, this approach has reversed a disease once thought unstoppable. Tonight, I’m launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes — and to give all of us access to the personalized information we need to keep ourselves and our families healthier.” Obama also indicated he would veto any attempts to rollback the Affordable Care Act. But in a speech to US Chamber of Commerce, Senate Finance Committee Chairman Orrin Hatch (Republican-Utah) vowed that Republicans will “strike away at it [Obamacare), piece by piece, if we have to.”

Some 16 million of 38 million deaths caused by noncommunicable diseases (NCDs) in 2012 were preventable, an increase of 1.4 million preventable NCDs annually since 2000, according to a World Health Organization’s Global status report on noncommunicable diseases 2014. “NCDs are driven by the effects of globalization on marketing and trade, rapid urbanization and population ageing – factors over which the individual has little control and over which the conventional health sector also has little sway. While individual behaviour change is important, tackling NCDs definitively requires leadership at the highest levels of government, policy development that involve all government departments, and progress towards universal health coverage,” WHO Director-General Dr. Margaret Chan states in the preface to the report. WHO’s Global action plan for NCDs 2013-2020 hopes to reduce premature NCD deaths by 25 per cent through global adoption of nine voluntary targets aimed at reducing such risk factors as tobacco use, salt intake, physical inactivity, high blood pressure and harmful use of alcohol.

Public Health England and National Health Service England unveiled a £11.5 million 10-point planto reduce England’s tuberculosis rate of 13.5 cases per 100,000 population, the second highest in Western Europe. The plan “will include improving access and early diagnosis; better treatment, diagnostic and care services; tackling TB in under-served groups and improved screening and treatment of new migrants for latent TB infection to bring about a year-on-year reduction in TB cases.”

The World Health Organization issued a plea for US$23 million to bolster access to medicines and primary, secondary and emergency health care services in war-torn Eastern Ukraine. “The Ukrainian health system was weak already before the crisis and is now completely collapsing in fighting areasand areas where many displaced people have found shelter. In and around the cities of Donetsk and, particularly, Luhank, government health care provision has been reduced to a minimum level, or is nonexistent in some cases. Essential services have broken down, including water and power supplies. Lootings and destruction of health care facilities are common; more than 50 health care facilities have been partly or completely destroyed.” WHO also indicated that “about 30 to 70% of health care workers have fled the fighting areas or died.”